The Medical Association and a coalition of health organizations this week convinced a legislative committee with oversight of state board regulations to make changes to a dangerous proposed regulation by the newly-formed Alabama State Board of Midwifery. The Midwifery Board was established by law in 2017 to license non-nurse midwives.

The proposed regulation – if adopted by the legislative committee as it was proposed by the Midwifery Board – would have allowed non-nurse midwives to practice pediatrics and procure, store and use drugs, neither of which is allowed by state law. In addition to striking these two provisions from the ASBM’s proposed regulation, the legislative committee also added a requirement that, in the event a woman attempting to give birth at home with a non-nurse midwife transfers to a facility, the non-nurse midwife is required to accompany her client. As well, the legislative committee struck language in the Midwifery Board proposed regulation that would have limited the ASBM’s disciplinary “look back” period to only 18 months. No professional health licensure boards in Alabama have such a limited timeframe for “look back.”

The Medical Association and others in the health coalition had worked with the Midwifery Board for more than six months in an attempt to get the Board to voluntarily bring its proposed regulation into compliance with state law. While the Midwifery Board chose not to accede to the coalition’s requests, the Medical Association supports the changes made to the proposed regulation by the legislative committee this week as being in the best interest of both pregnant women and their babies.

The Midwifery Board meets next week to take up the revisions the legislative committee made to its proposed rule. At that meeting or before the Dec. 4 deadline, the Midwifery Board will have to decide whether to adopt the changes the legislative committee made to its proposed regulation or to start over with the rulemaking process.

OPELIKA — Dr. Richard Freeman’s office at Pediatric Associates of Auburn (which includes Drs. Ellen Royal, Rian Anglin and Katie Wolter) overlooks beautiful woods where wild turkeys have been known to roam. Inside his office are keepsakes of his past from photos of his time in the U.S. Navy to an identical propeller from a Piper J-3 Cub, the airplane he learned to fly in.

In Tullahoma, Tenn., Dr. Freeman put his physics and mathematics degree to work as a civilian employee of ARO, Inc., a civilian contractor for the U.S. Air Force. Although the company had four divisions, he chose the aerospace environmental facility because it was responsible for outer space simulations. Before long, Dr. Freeman took advantage of a company perk, which allowed him to pursue his Master’s degree in physics. It wasn’t long when he decided a different career path would be in his future.

“I had about half the coursework done for my master’s degree in physics before I decided that I wanted to do medicine. The company doctor was a really nice gentleman who had been to Vanderbilt Medical School and had retired from his private practice to become our company doctor. He said ‘Son, resign this job, go to Knoxville, do a year of pre-med, and see how you like it. You might be surprised.’ And I did,” Dr. Freeman said.

Knoxville proved a wise decision, not only as a career choice but also as a personal one. While completing a year of pre-med courses, Dr. Freeman met his wife there.

“On our first date, I took Sherry flying. When I was working in aerospace research I had learned to fly and got my private pilot’s license. It was a great first date! We flew over Cades Cove and Fontana Dam. We’ve never forgotten it!” Dr. Freeman laughed.

After Knoxville, Dr. Freeman went on to the University of North Carolina School of Medicine at Chapel Hill. He still laughs as he recalls his first day and a special party at the dean’s house.

“The first day is usually for registration and getting books. After that, the dean, Dr. Isaac M Taylor, invited the class over to his home for a reception. There were two boys running around the house. One of the boys was Livingston Taylor and the other was James Taylor…that James Taylor…the musician,” he laughed. “Some of my classmates knew him because he had a band that played in town. Yeah…he was pretty good!”

After he finished medical school in 1970, Dr. Freeman landed in Birmingham where he did a mixed program of internal medicine and pediatrics in the first year of training preparing to stay for his internal medicine residency following completion of his pediatric residency. He had joined the U.S. Navy the year before his pre-med year at the University of Tennessee in Knoxville. However, after finishing his pediatric residency he received orders to report for active duty in the pediatric department at NAS Jacksonville. In August 1975, he was released from active duty and moved to Opelika where he practiced in a clinic for two years before moving to Auburn where he opened his own medical clinic. It was not long before it was time for him to put on another hat…preceptor for pre-med students.

“In 1977 I got a call from Dr. Frank Stevens who was the professor of chemistry at Auburn University,” Dr. Freeman explained. “The university was trying to start a pre-med program. He asked if I could have some students shadow me in my practice. We’ve been doing that ever since. It’s been years ago, but I had a patient who delivered a baby in Birmingham. When they got ready to go home, the neonatologist called to let me know they were sending the parents and the baby home and to set up an appointment for a follow-up. As it turned out, the neonatologist was one of my pre-med students from Auburn who had rotated through my office. Small world!”

Before long, the flying bug bit again when one of our office nurse’s husband, who happened to be a U2 pilot and flight instructor at Auburn University, invited him on a flight, which he couldn’t resist. Dr. Freeman already had his private pilot’s license and had monitored the Navy’s flight surgeon program when on active duty at NAS Pensacola one summer. He completed the program at Auburn University for a commercial instrument rating, a multi-instrument rating, and his flight instructor rating. Then, Auburn University asked him to become a part-time flight instructor.

“I’m not current, so I don’t fly now. I just pay Delta and bum rides,” Dr. Freeman laughed. “In 1985 the community needed an aviation medical examiner to issue medical certificates to qualified pilots, so I went to school in Oklahoma City for a week to get my certification. I’ve been an AME since 1981. We see airline pilots and Auburn students who are learning how to fly and talk about aviation and flying – it’s a lot of fun. When you’re an aviation medical examiner, you wear a different hat from being a medical doctor. Technically you’re not a treating physician. You’re really an agent for the Federal Aviation Administration. When I put on the AME hat, I’m not diagnosing and not treating but evaluating this person. It is a public service and I see the role from both sides having been a pilot as well.”

In August 2016, Dr. Freeman became a different type of instructor when he was asked to present lectures on various pediatric topics to VCOM Auburn University medical students.

“That’s been a lot of fun, and that’s another hat. I can’t just waltz into the classroom and throw slides up on the screen,” Dr. Freeman explained. “I have to study to prepare for my presentations. It’s good for me, too, because I learn with the students. As physicians, we should never stop learning. I get to refresh my memory, and the students definitely keep me on my toes.”

Dr. Freeman lives in Opelika with his wife Sherry. They have two children. Kelly and her husband, Charlie, live in Murfreesboro, Tennessee. They have three children — Elizabeth, Anna Jane and Charles. Mac and his wife, Ashley, live in Montgomery, and they also have three children — Mattie, Mac III and Annie Barnes.

UPDATED OCT. 12, 2017 — Legislation to renew funding for the Children’s Health Insurance Program has stalled in the U.S. House as lawmakers continue debating how to pay for the program. This is the third delay requested by the Democrats as the lawmakers now work to mark up the legislation to extend funding for critical programs other than CHIP, such as Community Health Centers and to provide an additional $1 billion to Puerto Rico’s Medicaid program.

Both parties agree on the urgency of passing a CHIP bill. Federal funding for the program expired Sept. 30, and the longer Congress delays taking action, the tougher it will be on states.

Eleven states anticipate they will burn through their federal funding by the end of 2017, according to the Kaiser Family Foundation, and 32 states project they will exhaust federal funds by the end of March 2018.

OCTOBER 6, 2017 — After being unable to come together to meet a Sept. 30 deadline that would have renewed funding for the Children’s Health Insurance Program for five years, lawmakers in Washington were back at the drawing board this week looking for solutions to ensure federal funding for CHIP even though the Senate Finance Committee reached a bipartisan deal in mid-September to extend funding for five years.

Earlier in September, the U.S. Senate Finance Committee reached an estimated $8 billion bipartisan agreement to renew CHIP funding for five years and phase out the 23 percent Obamacare funding bump. States would have maintained eligibility through 2019, and after that there would be no so-called maintenance of effort for children of parents with incomes more than 300 percent of the federal poverty level.

The Medicaid and CHIP Payment and Access Commission has estimated that all states will exhaust their federal CHIP reserves in 2018 without an extension but warns that an extension alone will not be enough.

“If Congress extends funding but does not include the 23 percentage-point increase in the federal matching rate that was provided in the ACA, most states will still face shortfalls, since many assumed continued funding with the enhanced match rate,” it noted.

In Alabama, CHIP funding is split between Alabama Medicaid and the Alabama Department of Public Health. ADPH administers the ALL Kids program, which covers about 83,000 of Alabama’s children, while Medicaid provides covers for an additional 70,000 children.

The Medical Association, the Alabama Chapter of the American Academy of Pediatrics, state lawmakers and a number of organizations advocating for children’s health care petitioned the Alabama Congressional Delegation to support reauthorization of a bipartisan CHIP funding bill before the Sept. 30 deadline. In a letter to the Alabama Congressional Delegation outlining support for CHIP reauthorization, the coalition cited the great strides made possible through CHIP in ensuring children have access to the care they need. As well, any reductions in federal CHIP funding could cause problems for not only Alabama’s ALL Kids program but also children enrolled in Alabama Medicaid.